The Impact of Valsalva Manoeuvres and Exercise on Intracranial Pressure and Cerebrovascular Dynamics in Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disease characterised by elevated intracranial pressure (ICP). The impact of straining and exercise on ICP regulation is poorly understood yet clinically relevant to IIH patient care. We sought to investigate the impact of Valsalva manoeuvres (VMs) and exercise on ICP and cerebrovascular haemodynamics in IIH. People with IIH were prospectively enrolled and had an intraparenchymal telemetric ICP sensor inserted. Three participants (age [mean ± standard deviation]: 40.3 ± 13.9 years) underwent continuous real-time ICP monitoring coupled with cerebrovascular haemodynamic assessments during VMs and moderate exercise. Participants had IIH with supine ICP measuring 15.3 ± 8.7 mmHg (20.8 ± 11.8 cm cerebrospinal fluid (CSF)) and sitting ICP measuring -4.2 ± 7.9 mmHg (-5.7 ± 10.7 cmCSF). During phase I of a VM ICP increased by 29.4 ± 13.5 mmHg (40.0 ± 18.4 cmCSF) but returned to baseline within 16 seconds from VM onset. The pattern of ICP changes during the VM phases was associated to that of changes in blood pressure, the middle cerebral artery blood velocity and prefrontal cortex haemodynamics. Exercise led to minimal effects on ICP. In conclusion, VM-induced changes in ICP were coupled to cerebrovascular haemodynamics and showed no sustained impact on ICP. Exercise did not lead to prolonged elevation of ICP. Those with IIH experiencing VMs (for example, during exercise and labour) may be reassured at the brief nature of the changes. Future research must look to corroborate the findings in a larger IIH cohort.

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© 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

Déclaration de conflit d'intérêts

AY reports receiving speaker fees from Teva, UK, outside the submitted work. SPM reports other Invex Therapeutics, other Heidelberg engineering during the conduct of the study; other from Chugai-Roche Ltd, other from Janssen, other from Allergan, other from Santen, other from Roche, and other from Neurodiem, outside the submitted work. AJS reports personal fees from Invex therapeutics in her role as Director with stock holdings, during the conduct of the study; other fees from Allergan, Novartis, Cheisi and Amgen outside the submitted work. The other authors report no conflicts of interest. The views expressed are those of the authors and not necessarily those of the UK National Health Service, MoD, NIHR, or the UK department of Health and Social Care. Role of Funder/Sponsor: The MoD, NIHR and the MRC had no role in the design or conduct of the study; no role in collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript; and no role in the decision to submit the manuscript for publication in the design, execution or write up of this sub-study of the trial.